Pain in the ball of the foot is a common occurrence, especially in individuals who play sports or wear certain types of shoes.
Two of the most common conditions that affect the ball of the foot are Morton’s Neuroma and metatarsalgia.
These two conditions are similar in a lot of ways. But they do have several important differences.
Understanding the differences and similarities can help your doctor correctly diagnose your foot pain and treat it effectively.
Let’s have a look at Morton’s Neuroma and metatarsalgia to help you figure out what’s causing your foot pain.
What Are Morton’s Neuroma and Metatarsalgia?
Both Morton’s Neuroma and metatarsalgia are foot conditions that affect the ball of your foot.
While they have similar symptoms—including numbness, pain, and inflammation in the ball of the foot—they are actually two different conditions.
Morton’s Neuroma commonly affects the tissue around the interdigital nerve between the 3rd and 4th toes in the ball of the foot. Most people who have Morton’s Neuroma will often experience tingling or numbness in the 3rd or 4th toe.
With metatarsalgia, pain is felt under the ball of the feet beneath the 2nd and 3rd metatarsal heads. When walking, many people experience pain across the ball of the foot—where the toes meet the foot—and may notice swelling across the front of the foot as well as into the toes.
Let’s go into more detail on both.
Morton’s Neuroma
Morton’s Neuroma—also known as intermetatarsal neuroma or interdigital neuroma—is a painful foot condition that develops when the tissue around the plantar digital nerve—the nerve that leads to the toes—thickens.
This places pressure on the bones and ligaments around the nerve, which causes more irritation and inflammation. When this happens, you may experience numbness, a tingling or a burning sensation in the 3rd and 4th toes.
Another sign of Morton’s Neuroma is that you feel a pronounced lump along the metatarsal shaft between the 3rd and 4th toes. If squeeze your foot widthways, you may hear a clicking sound.
Morton’s Neuroma rarely occurs around the nerves between the 1st and 2nd or 4th and 5th metatarsal bones. It’s very rare to have two neuromas in one foot, and the condition tends to only affect only one foot.
Potential Causes
Sporting activities that increase the pressure on the forefoot and expose your feet to repetitive trauma such as running, basketball, and tennis can cause Morton’s Neuroma.
Activities like ballet, dancing, and skiing can also increase the risk of Morton’s Neuroma, as these activities require tight-fitting shoes.
That being said, certain foot conditions such as flat feet, bunions, hammertoes, high arches, or unusually flexible feet can put you at a higher risk for developing Morton’s Neuroma.
These conditions can create an uneven weight distribution that places excessive stress on the metatarsal bones, which can irritate the nerve and lead to a neuroma.
An injury or trauma can cause a neuroma in the feet, especially if this injury alters your gait. This can create instability and place excessive pressure on the interdigital nerve in the foot.
One of the most common causes of Morton’s Neuroma is wearing ill-fitting shoes or shoes that compress the forefoot, such as shoes with a tapered toe box.
High-heeled shoes that have a heel over three inches high cause your foot to move forward in the shoe. This creates a pressure point in the forefoot that can cause a neuroma.
What are Typical Symptoms?
The symptoms of Morton’s Neuroma develop over time. Often, people may only notice symptoms when they’ve been on their feet for an extended time.
Or when they’ve performed an activity that aggravates it. Wearing narrow—or high-heeled—shoes can also trigger symtoms.
You may experience severe or intermittent pain in the foot and only find relief by removing your shoe and resting your foot. Or you may notice a burning, tingling, or even numbness that radiates into the ball of your foot.
It may feel as though you’re walking with a pebble in the shoe, or like something is inside the ball of your foot.
As the neuroma enlarges, these symptoms can become more intense, with the worst of the pain being felt in the ball of your foot. The symptoms can last for a few days or even weeks and if left untreated then the damage to the nerve can become permanent.
What are Possible Preventions and Treatments?
Fortunately, Morton’s Neuroma by often be treated by making small, simple changes.
The first step is to change the types of shoes or sandals that you’re wearing. Get shoes that have a wide toe box that allows your toes to splay naturally, without the metatarsal bones overriding each other.
There should be at least a thumbs-width of space between your longest toe and the front of the shoe. Make sure that the shoes provide adequate arch support for your foot shape.
This will help to reduce the amount of pressure that’s placed on the forefoot, as your body weight is evenly distributed and will reduce the amount of shock that’s absorbed by your foot.
Look for shoes that have a low heel-to-toe drop, as this will reduce the amount of pressure on the metatarsal bones. It will also reduce the risk of developing Plantar Fasciitis, especially if you overpronate.
You can use orthopedic insoles that have anatomical arch support, as these will not only reduce the pressure on the neuroma, but they’ll provide additional cushioning to the inflamed tissue. Orthotic insoles can help realign your foot so that it moves more naturally, which will reduce the pressure on the neuroma.
There are metatarsal pads that can fit in their shoes to support the metatarsal arch—just behind the toes—which will help to reduce the pressure on the interdigital nerves in the foot. These can also help to reduce the amount of compression that’s placed on the neuroma when walking.
Rest your foot as much as you can throughout the day and gently massage the area several times a day, as this will help to alleviate the symptoms.
To help alleviate the pain, you can use nonsteroidal anti-inflammatory medication such as Advil, Ibuprofen, or Motrin. You can also ice the affected area for 20 minutes 3 to 4 times a day. Applying athletics or KT tape for morton’s neuroma can also help.
Do gentle stretches on both feet, as this will help to loosen tight tendons and ligaments in the foot. Look at incorporating strength exercises that will help develop the strength in your foot and ankle, as this will help alleviate the symptoms and prevent other foot conditions.
Depending on the severity of your Morton’s Neuroma, your doctor may prescribe corticosteroid injections to alleviate the pain.
In severe cases or if the pain and symptoms don’t subside, then your doctor may recommend a decompression surgery, neurectomy or cryogenic surgery to resolve the neuroma.
Metatarsalgia
Metatarsalgia is the medical term that’s used to describe pain, tenderness, and inflammation in the ball of the foot.
When suffering from metatarsalgia, the pain will be felt across the ball of the foot by the metatarsal heads that are just under the toes.
Metatarsalgia most commonly affects the base of the 2nd toe, but can also affect the 3rd and 4th toes. It develops gradually over a few weeks and it can feel worse when you walk, stand, or extend your toes.
It may affect one or both of your feet as when you walk—or run—your body weight is transferred to the metatarsals—the five long bones in your feet that run across the bridge of your foot to your toes.
If your body weight is distributed unevenly when your foot comes into contact with the ground, then the metatarsal bones—metatarsal heads—can become inflamed and irritated. This will cause the pain to radiate across the fatty pad just below the toes.
Potential Causes
There are a number of conditions that can cause metatarsalgia, with the most common cause being an overuse injury.
You may not notice any symptoms of an overuse injury in the beginning, as it starts gradually and very often doesn’t cause enough pain to stop immediately from what you were doing.
However, repetitive activities like walking—even while doing our daily activities—places the metatarsals under constant, localized pressure, which then leads to the pain that we notice in the forefoot.
Wearing shoes that don’t provide adequate support for your foot shape or wearing shoes that no longer provide cushioning will increase your risk of metatarsalgia, especially when doing high-impact sports.
This is often due to the fact that the shoes don’t reduce the shock of impact, cushion the forefoot, or support the arch of the foot to distribute your body weight evenly. This places the metatarsals under constant pressure.
Shoes that have a narrow toe box will compress the metatarsals and cause them to rub against each other, leading to inflammation and irritation.
High-heels shoes shift your body weight onto the ball of the foot, and over time the metatarsal becomes inflamed from the localized pressure that’s placed on the forefoot, leading to metatarsalgia.
Metatarsalgia can be caused by other conditions, such as rheumatoid arthritis, gout, hammer toes, and bunions. But some people may develop metatarsalgia if they have prominent metatarsal heads, high arches, tight toe extensors, weak toe flexors, hypermobile first ray, or tight Achilles tendons.
As we get older, our feet change shape and we start to lose some of the protective layers of fat in the ball of the foot. This is known as fat pad atrophy.
With metatarsalgia, you’ll often find that calluses will form under the ball of the foot where the metatarsal heads are. These calluses can be sensitive and cause severe pain when pressure is applied to them.
What are Typical Symptoms?
One of the main symptoms of metatarsalgia is tenderness and pain that extends across the forefoot—metatarsal fat pad. Often, calluses form on the skin underneath the metatarsal heads.
You may even feel a burning sensation, shooting pain, tingling, or numbness in the forefoot. Sometimes, there may be swelling on the top of the foot going into the toes, but it’s not uncommon for no swelling to appear. It will be uncomfortable to walk or stand, as it feels as though you have a stone in your shoe.
The symptoms of metatarsalgia can feel worse during movement, especially when you’re walking barefoot over hard floors, when your foot pushes against the ground when you’re walking, or when you flex your toes.
The pain can occur in both feet and some people may only experience pain under one or two metatarsal heads. Other people may feel pain across all metatarsal heads.
What are Possible Treatments or Preventions?
When experiencing metatarsalgia, it can be painful and very uncomfortable, to the point where it can interfere with your daily activities. Fortunately, there are some self-help measures that you can take to treat and prevent metatarsalgia.
One of the best ways to alleviate metatarsalgia is by resting your feet, with them elevated, and avoiding any activity that makes the pain worse. If you want to maintain your fitness, try low-impact activities like swimming or cycling.
Change your footwear and look for metatarsalgia shoes that have a low heel-to toe drop, as this will reduce the pressure that’s placed on the forefoot. The shoe must have adequate arch support and cushioning in the forefoot.
Make sure that the toe box is wide, as this will allow for your toes to splay naturally and will accommodate your foot when it swells. Replace any shoes that are worn out and don’t provide adequate cushioning or support for your feet, as this can exacerbate the condition.
You can look at using metatarsal pads or orthotic insoles, as this will reduce the pressure that’s placed on the metatarsal heads and alleviate pain in the forefoot. Inserts specific for metatarsalgia or fat pad atrophy can be purchased over the counter.
Maintain a healthy weight and if you do need to shed some extra pounds then adopt a balanced diet and regularly do low-impact exercises. By reducing your weight, you’ll be reducing the amount of pressure that’s placed on the feet and joints.
To alleviate pain and to reduce inflammation, use over-the-counter pain medication such as Ibuprofen, Advil, or Motrin.
